Breast Reduction

What is Breast Reduction (Female)?

Breast reduction surgery is a common plastic surgery procedure that serves to reduce the overall volume of breast tissue and to address symptoms of neck and back discomfort, while also producing a more lifted appearance to the breast mound and providing an overall breast shape where the nipple is situated forward-facing over the most projecting aspect of the breast.

Who in Birmingham, Alabama would be a good candidate for Breast Reduction Procedure?

We think women with large, heavy breasts who feel that smaller breasts will address symptoms that they relate to their breast weight (i.e. neck/back pain, shoulder grooves from bra straps,etc) are good candidates for a breast reduction. Ideal candidates are healthy women who are non-smokers. Additionally, some women may elect to undergo breast reduction surgery in the absence of any symptoms because they feel that their breasts are out of proportion with their body frame or because they feel too “top-heavy” in clothing.

How is the procedure performed?

We perform our breast reductions in a hospital in Birmingham as an out- patient surgery, although some of our patients choose to stay the night in the hospital. The procedure typically takes 3-4 hours and is performed under general anesthesia. Breast reduction surgery is performed by rearranging the internal architecture of the breast to provide a more lifted, supported appearance. In almost all cases, the nipple remains connected to the underlying breast tissue, and the skin of the breast is contoured and tightened to address and remove skin excess while supporting the new shape. The breast tissue is reorganized within the breast skin “envelope” by using sutures and designing the resection so that optimal shape is achieved. Incisions and scar patterns typically incorporate a circular incision around the perimeter of the nipple and a vertical incision that runs along the lower half of the breast beneath the nipple towards the breast fold. In severe cases of breast skin excess, an incision may be also required along the fold/crease beneath the breast. In your consultation, we will be able to give you a better sense of what type of scar pattern is required to achieve the best results in the final shape of your breasts (based on their individualized anatomy).

What is the post- operative recovery?

Recovery from breast reduction surgery is generally straight-forward and relatively prompt. Many patients feel that they begin resumption of normal activities several days following the procedure. Activities that utilize substantial physical activity or cause bouncing/movement of breast tissue should be limited for the first week or so, but most patients feel as though they can resume work and activities of daily living very promptly following the procedure. Allowing about a week or two to recover from some generalized soreness seems to be adequate in most cases. In cases where a substantial quantity of breast tissue is being removed, a patient may benefit from a small drain tube placed within the breast for the first several days following the procedure. We will remove this tube in the office in Birmingham during the early post-op period.

What can I expect for results?

Birmingham patients can expect their breast to have a more lifted appearance with a substantially less heavy feel. Most women can appreciate the difference in neck/back strain as early as the surgical recovery room immediately following the procedure. The breast shape is initially somewhat over-exaggerated, but settles into a more natural shape and position over the first several weeks. Scars can be somewhat pronounced during the first several months as they mature, but typically fade over the first year to become less visible.

Are there any potential complications?

Like all operations, bleeding and infection are standard risks. A breast reduction can have complications but, fortunately, they are rare. Final scar appearance can have a degree of unpredictability in certain patients and may require revision if deemed unsatisfactory. Depending on the extent of nipple movement required to get a lifted position and the amount of breast removed, rare complications resulting from altered blood supply to the nipple can affect overall nipple sensation or healing of the nipple region.

Are there additional relevant considerations regarding this procedure?

Will I still be able to have normal nipple sensation following breast reduction? In the majority of cases, women do not have significant change in nipple sensation following breast surgery. Risks for such changes increase in breasts that require more extensive movement/elevation of nipple position or that require larger volume reductions.

Will I be able to breast feed following a breast reduction? Science has shown that the overall success rate of breast feeding following breast surgery is similar to the overall success rate of breast feeding in women who have not undergone breast surgery. Essentially, one-third of women are able to successfully breast-feed after surgery, one-third of women have no desire and do not attempt to breast feed, and one-third need to supplement their breast feeding with store-bought formula. As a general rule, breast reduction surgery is best done following completion of all anticipated pregnancies so that post-partum changes do not negatively impact the final surgical result and interference with successful efforts at breast-feeding are minimized.

Will insurance cover my breast reduction? Different policies have differing criteria by which the insurance companies use to determine coverage for breast reduction surgery. Some companies require that a certain amount/weight of breast tissue be removed in order to meet coverage criteria, while other policies require documentation of symptoms and failed non-surgical management prior to surgery. During your consultation, you will have an opportunity to meet with our friendly and knowledgeable clinical coordinators who will be able to look at your policy to assist in determining how to go about ascertaining if your particular policy provides coverage for breast reduction services.

Breast Reduction (Male)

Gynecomastia is the medical term for excessive male breast tissue. The condition often begins during adolescence and is benign in most cases. There are medical concerns that can accompany some forms of gynecomastia (endocrine conditions, testicular tumors), but fortunately such instances are rare. The condition can also result from substantial weight gain or loss and can produce feelings of self-consciousness in men who desire to have a flatter, less pronounced chest shape.

Who is a good candidate?

We think that healthy males with realistic expectations about the degree of improvement they can expect to see following the procedure are ideal candidates for gynecomastia surgery.

How is the procedure performed?

We perform most of our male breast reductions at our fully accredited operating facility in Birmingham. The procedure typically takes 1-3 hours and in most cases is performed under general anesthesia. Certified Registered Nurse Anesthetists (CRNA’s) keep you completely safe and comfortable throughout. If your gynecomastia is a procedure that your insurance will cover (see below), the procedure will be performed in a hospital as an out-patient surgery.

Most men are able to achieve an excellent surgical result using either liposuction techniques alone or liposuction techniques in conjunction with a small excision of breast tissue through discrete incision placement. If liposuction alone is performed, fluid is initially injected into the excess breast tissue. This assists with post-operative pain control and bruising. Following placement of this fluid into the tissue, small metal cannulas are used to perform controlled liposuction to remove unwanted fatty tissue and provide improvement in contour. The incision for liposuction is very small and able to be closed with a single stitch. Many men also have a small area of fibrous tissue directly beneath the nipple, and if this area produces unwanted prominence following liposuction, a small incision on the chest or near the nipple may be made to facilitate excision of this tissue. In patients with large amounts of skin excess, often times liposuction alone will not assist completely with providing optimal improvement in contour or nipple position. Such cases of skin excess may require removal of skin and/or efforts at repositioning the nipple. Incisions are individually planned and designed to be as inconspicuous as possible. You are placed in a post-operative compression vest to assist with swelling for the first several weeks following the procedure.

What is the post-operative recovery?

Recovery following gynecomastia surgery typically has very minimal down-time and is very prompt. Many patients feel that they can begin resumption of normal activities a day or so following the procedure. Following surgery, there is some anticipated bruising and swelling, but incisions are usually minimal, and as such, most men do not require substantial time off of work or recovery period. If breast skin excess needs to be removed in addition to performing liposuction of underlying breast tissue, incisions may need to be more extensive, and this may impact the overall recovery period.

What can I expect for results?

During the early post-operative period, you will be able to see a flatter, more masculine chest. Some expected and anticipated bruising and swelling typically lingers for the first week or so, with the majority of swelling being gone by around 6 weeks following the procedure.

Are there any potential complications?

Like all operations, bleeding and infection are standard risks. A gynecomastia procedure can have complications but, fortunately they are extremely rare. Grotting & Cohn Plastic Surgery offers CosmetAssure (to our cosmetic patients) to protect you financially if a complication does arise (see CosmetAssure). Small surface irregularities in contour may be seen following any type of liposuction procedure and scarring may take several months to fully mature.

Are there additional relevant considerations regarding this procedure?

Is any particular “type” of liposuction better than another to address gynecomastia? We find that utilizing conventional liposuction techniques in conjunction with ULTRASONIC liposuction is especially helpful in the treatment of gynecomastia. Male breast tissue tends to be exceptionally dense and fibrous when compared with fatty tissue in other parts of the body (lower tummy, love handles, hips, etc.). Use of ultrasonic-assisted liposuction (UAL) assists with melting and disrupting fat cells in such a manner so as to achieve a more predictable, less-traumatic contour change. Additionally, the controlled degree of heat that is generated from the tip of the UAL cannula is felt to assist somewhat with post-operative skin tightening and optimizing issues that may result from skin with excessive pre-operative laxity.

Is gynecomastia covered by insurance? Different policies have differing criteria by which the insurance companies use to determine coverage for male breast reduction surgery. In most cases, the procedure is felt to be cosmetic in nature, and as such, is not readily covered by insurance.

Schedule a Breast Reconstruction consultation with Dr. Grotting and Dr. Cohn. They will devise a plan that will fit your aesthetic needs and features. Call our Birmingham, Alabama office at (205) 930-1600.

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